Guideline for Posterior Atlantoaxial Internal Fixation Assisted by Orthopaedic Surgical Robot

Abstract

Atlantoaxial transarticular facet screw fixation (Magerl technique) and C1 lateral mass screws combined with C2 pedicle screws fixation (Harms technique) are the most commonly used techniques for posterior internal fixation in the upper cervical spine. Upper cervical spinal surgery is a technically demanding and challenging procedure because of complicated anatomical structures and frequent occurrence of anomalies. Accurate insertion of screws allows for stable and secure internal fixation, which is necessary for both techniques. Traditional methods under fluoroscopic assistance in this region cannot meet the requirements of high levels of accuracy and security during the procedure. Robot‐assisted spinal surgery can provide accurate and reliable guidance during the screw insertion, which is evidenced in the literature. As a recently developed technique, robot‐assisted surgery is supposed to be performed by skilled surgeons who have received standard training for robotic surgery. The standardized upper cervical spinal surgery assisted by the robot system needs to be introduced to these surgeons. Based on the consensus of consultant specialists, the literature review, and our local experience, this guideline included the introduction of the robotic system, the workflow of robot‐assisted procedures, and the precautions to take during procedures. This guideline aims to provide a standardization of the robotic surgery for posterior atlantoaxial internal fixation.

Comparison of Outcomes between Robot‐Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion and Oblique Lumbar Interbody Fusion in Single‐Level Lumbar Spondylolisthesis

“…Robotic assistance theoretically increases accuracy in spinal surgery by ensuring that the placements follow the planned trajectories. Hence, we present the TiRobot system, which is a multi‐indication orthopaedic surgical robot that can be used for all levels of spinal instrumentation and pelvic, acetabular, and limb fracture surgeries 27 , 28 . The robot allows clear visualization of the three‐dimensional spinal anatomy, which enables the surgeon to choose the optimal entry point and trajectory for pedicle screw placement.…”

Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases

“…Except for pedicle screw placement, the previous article also reported the application of robot technology in the guidance procedure of percutaneous transforaminal endoscopy and vertebroplasty surgery, anterior odontoid screw fixation, posterior C1-2 transarticular screw fixation, cortical trajectory for pedicle fixation, and translaminar lag screw fixation. [2][3][4][5][6][7][8][9][10][11][12] More complicated telerobotic cases would be performed based on the 5G network in the future. Not only spinal surgery could benefit from this high-speed network, but also other surgeries like cardiac surgery, urinary surgery, and hepatobiliary surgery.…”

“…3 After several years of development, testing, and research, the TiRobot system has been proved to be reliable and efficacious in full-length spinal surgery. [4][5][6][7][8][9][10][11][12] Remote surgery is based on the mutual telecommunication of medical information. Medical information, such as image, audio, and video, are digitized and transmitted via cable or wireless telecommunication networks.…”

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

“…44 Furthermore, the TianJi was used to perform screw internal fixation in the upper cervical spine (C1 and C2) with excellent results. 45,46 In a randomized controlled study, 98.3% of the screws were graded A with minimal deviation in respect to the preplanned trajectory. 47…”